AB1307 RHEUMATIC SYNDROMES INDUCED BY ONCOLOGIC AND HEMATOLOGIC TARGETED THERAPIES
Authors: J. A. Gómez-Puerta, M. Tormo-Ratera, A. Ponce Fernandez, L. Farran, B. Frade-Sosa, J. C. Sarmiento Monroy, J. Narváez
Journal: Annals of the Rheumatic Diseases (2022)

Background Targeted therapy has gradually become the first-line clinical therapy for solid tumors and hematologic disorders (1). Immune related adverse side effects (irAE) due to checkpoint inhibitors are well recognized side effects in patients with underlying oncologic disorders; however, information regarding rheumatic side effects due to several targeted therapies are rarely reported. Objectives Our aim was to describe the main rheumatic syndromes induced by targeted therapies. Methods This observational study included patients from 2 referral University centers in Barcelona. We included patients referred from Oncology and Hematology departments visited from January 2017 to January 2022 at Hospital Clinic and Hospital de Bellvitge, Barcelona, Spain. Results Fifteen patients were included (Female 60%), with a mean age 63.3± 10.8 years. Nine patients had hematological disorders and 8 solid tumors. Main diagnosis included Multiple Myeloma in 3 (20%) patients, Non-Hodgkin Lymphoma 2 (13%), Acute Myeloid Leukemia 2 (13%), Melanoma 2 (13%), Colon carcinoma 1 (6.7%), Breast carcinoma 1 (6.7%), Glioblastoma multiforme 1 (6.7%), Chronic lymphatic leukemia 1 (6.7%), Renal cell carcinoma 1 (6.7%) and Sésary Syndrome in 1 (6.7%) patient. Targeted therapies included MAP kinases in 4 (26.7%) patients, Anti CD-38 in 3 (20%), Anti BRAF in 2 (13.3%), and anti STAT-3, anti VEGF, BTK inhibitor, anti CCR4, Isocitrate dehydrogenase 2 inhibitor and Halichondrin B analoge in 1 (6.7%) patient each. Treatment was administrated as monotherapy in 9 (60%) and as combined therapy in 6 (40%). Mean time from the initiation of targeted therapies and rheumatic syndrome onset was 5.0 ± 3.8 months. Main rheumatic syndrome were: Polymyalgia rheumatica (PMR) in 4 (26%) patients, Raynaud’s phenomenon in 2 (13%), Tenosynovitis in 2 (13%), RA-like 2 (13%), cutaneous vasculitis, amyopathic dermatomyositis, oligoarthritis, spondyloarthropathy-like and non-inflammatory arthralgias in 1 (6.7%) case each. Main clinical characteristics are summarized in Table 1. In 8 (53%) cases, targeted therapies were stopped due side effects. Rheumatic syndrome were treated with, glucocorticoids (GC) 12 (80%), calcium antagonist 2 (13%), Hydroxychloroquine in 2 (13%), Methotrexate in 1 (6.7%), Sulfasalazine in 1 (6.7%) and NSAID in 1 (6.7%) patient. Mean follow-up were 15.4± 20 months. Most of the patients remain alive (86%). According oncologic prognosis, 4 (26%) had complete response, 6 (40%) had partial response and 5 (33%) had disease progression. At the time of the last visit, 6 (40%) patients remain on GC (mean dose 6.7 ± 4.7 mg/d) and 4 (26%) patients on DMARD therapy. Conclusion In this heterogeneous group of patients treated with targeted therapies, we described a variety of induced rheumatic syndromes including PMR, arthritis, and even vasculitis or dermatomyositis. An important proportion of patients stopped the treatment due to side effects and some of them required sustained treatment including GC and DMARD. References [1]Castelli MS et al. Pharmacol Res Perspect. 2019 Dec;7(6):e00535. Table 1. Main clinical rheumatic syndromes induced by targeted therapies Disclosure of Interests José A Gómez-Puerta Speakers bureau: Abbvie, BMS, Galápagos, GSK, Janssen, Lilly, MSD, Pfizer and Roche, Consultant of: Galápagos, Roche and Sanofi, Marian Tormo-Ratera: None declared, ANDRES PONCE FERNANDEZ Speakers bureau: Lilly, Novartis, Laura Farran: None declared, Beatriz Frade-Sosa Speakers bureau: Abbvie, Juan Camilo Sarmiento Monroy Speakers bureau: GSK, J. Narváez: None declared